I feel SO frustrated by an RPN who seems to be deliberately trying to provoke me. My DH is at a stage where he is so vulnerable … he is afraid that I won’t be there for him, (has reverted back to his language of origin (Swiss-German), cannot really communicate with others other than to wave and speak in his own language, feels abandoned, etc.
This particular RPN is intimidating … at one time my DH said she was ‘pushing him around’. I asked her about this, but she said he was pushing his wheelchair away from the table, and could possibly have backed into another resident, plus she was stressed about an accident wherein a PSW and family had lost their lives. She said it wasn’t her fault.
The first troubling issue months ago (for me) was when she helped toilet him (thankfully,very rarely). She talked on and on and on about personal matters with a PSW during the toileting. He was on a SaraLift- naked from the waist down, and so vulnerable – I could see his distress (he was always private and dignified), and I finally said “Too much personal talk!” The PSW apologized and they left. I apologized to J. the next day, only because I did not want repercussions on my DH.
This has shaped a battle between us … and I HATE it. I am his POA. I eat supper with him every night, and he has told me that he wants me to order for him because he gets confused and doesn’t know what to order (They present 2 plates to view). When other staff have asked, I say what we should eat … never any problems. This particular RPN tries to ignore me, asking him what he would like to order. In frustration, the other day I told her, “I am his POA, and I say he gets chicken”. She said “you don’t have to be like that”, and I held my tongue from saying “I am only responding to your actions.”
In spite of my comments, tonight she again asked, and he pointed at something different than I ordered … after he had tasted it, he said he didn’t like it, and I returned it, saying he didn’t like it, and I had already told the RPN previously that I was his POA and I would be ordering for him – meaning she is ignoring my request.
I have had NO problems with any other of this staff – not one single incident - they have been caring and very kind to him. He is very fragile now, and scared. There are two areas of conflict with this RPN … mealtime (she is mostly on the 2- 10 pm shift - suppertime) … as described above. The other is his medications, which she is responsible for. I am so frustrated by her actions – she can be so cold and intimidating that I want to be present when she is giving his night meds before I leave (normally 7:30-8:30 p.m). His doctor has ordered (as per an RN) that he now get his night meds about 7-7:15 p.m, which allows him to sleep, and me to leave earlier and get some rest. This RPN has given his meds (ground with applesauce) with no water or juice to wash them down. I told her that he hates the water, so she says she will wait until the snack cart comes around, and she only needs by law to give his meds by 9 p.m.
A few nights ago he was crying, sad and very distressed, and I asked her if she would give him an Ativan (PRN, which I only ordered 3 times in 5 months) plus his night meds. She said she was on her break, but would deal with it later. After 45 minutes I looked in the corridor – she was going from one end to the other, checking to see where I was, avoiding me. After 45 minutes I asked her … “are you going to give my DH his meds?” She said she was busy. Then I said I was going to the RN … while I was contacting the RN, she sneaked into his room and gave his meds. When the RN came, she said she had given his meds. It took 45 minutes to give an upset resident his meds, and 2 minutes torun to the RN to report that I was frustrated with her. These games I feel she is playing are upsetting.
I realize that I have to view the long-term, not the short term battles, but it is HARD. He is so sad, saying that he doesn’t have much time left, and we should be together; I know that if I take him home I will be not able to handle his care alone. Also, this facility is really good, aside from her.
I have again begun documenting the problems as they arise. I am torn between wondering if my own grief is making her into something bigger than she is, and thinking that she is not sensitive enough to deal with these very vulnerable people … I’ve witnessed a few incidents with other residents where I felt she was SO lacking in the compassion needed.
Seems like she has an authority complex. Keep on her, she is going to fight you all the way.Early on ,Dh had a CNA that would not do what I asked,kept saying he was too combative(evryon else said he was so easy to care for).In front of DH she said"he doesn't know anything".She wasfiredas soon as I reported her. I am surprised that the LPN you have problems with is not set straight by her supervisor. I would be so frustrated if I were you.
marg78, I understand your frustration. A couple of weeks ago I was with two CNA's while there were changing DH. He sat down in his merry walker and she started screaming at him at the top of her lungs for him to stand up. She screamed that she did not have time to fool with him because her back was killing her. I calmly told her that he probably did not understand a word she said. She said he understood every word she said and she did not care if I reported her. I told her that I knew the work was hard and did not pay much and I would not tattle on a CNA for yelling but would if physical abused ever occurred. I told her that I appreciated all the hard work CNA's did. I walked in front of DH and put my palms straight up and calmly asked him to stand up. He did. Later the other CNA came to me and apologized stating that my DH had done nothing to deserve her outburst. During the next few visits the belligerent CNA was extremely friendly to me. I haven't seen her during my last two visits so hopefully she has quit. She definitely did not have the compassion it takes to be in the health care business. CNA's are the ones that I appreciate most at the NH and most of them are hardworking and kind to the patients. I have no appreciation for the RN's and Administration. You are wise to document your problems. Should you have to report her you can do so with dates, times and details of the incidents. Helps to have ammunition when you have to go into battle.
SInce the rest of the staff are caring and kind, they must have a good head nurse, or director of care. I would ask for a meeting with whoever is in charge of nursing care and bring your concerns to her, emphasizing that you appreciate the expertise of the rest of the nursing staff, but not these problems with J.. I had a similar problem when I was a patient recently in our largest hospital. There was a practical nurse, or aide, there who was so bad it bordered on cruelty (there are bad apples) that I told the RN in charge, in the presence of the aide, that I refused to be taken care of by the aide and to keep her away from me. The RN calmly told the aide that she, the R.N., would answer my call light herself from then on. When I thanked the RN later on in private, she said, "My patients are my concern and responsibility." You could run the risk of this backfiring on you if the whole setup is faulty. But since you are satisfied with all other aspects of care, I think you will be doing the person in charge a favour if you bring this (what appears to be a personal problem of J's) to the person in charge's attention. Who knows, she may be waiting for just such a complaint to deal with, or fire, this person. You are going to have to be so tactful, but firm, that you might even try rehearsing (even with another person) how you'll deal with person in charge: what you will say, what she might say back, so that you're not caught of guard. Be prepared. Another idea is to take someone else with you. It will help calm you, and you'll have a witness. I make it sound like a big deal, but I think it is. You may have to take a lot of flak. It is wonderful training for dealing with the world later on. Once a caregiver - never a patsy again. One of the few pluses of our long journey.
marg, I could not agree more with mary's advice about rehearsing what you will say to the head nurse. If you have a friend who will role-play, even better because you could practice several differnt scenarios of how the head nurse might respond. If your friend could go with you, all the better.
When you talk to the head nurse, I would NOT cast this as a personal dispute between you and the RPN. Instead, say you are concerned that your husband's well-being is affected by the RPN's behavior. You should appear concerned, not angry.
(1) -- Describe the episode when the RPN left him naked while she engaged in a personal conversation with another staff member. Tell her that your husband was obviously upset by being displayed naked for so long and that you had to ask the RPN to stop the personal talk so she could finish the toileting task.
(2) -- Tell the nurse you are worried that the RPN's negative behaviors are affecting his nutrition. Just say that after X years of marriage, you know what your husband likes to eat but the RPN deliberately gives him the opposite of what you recommend. And he won't eat it because he doesn't like it. (I would NOT mention the POA at this point - it sounds too legalistic.) The point is that the RPN is negatively affecting your husband's eating habits.
(3) -- Then tell the nurse that you fear the RPN's behavior regarding the meds is harming your husband. Describe the recent incident. Explain that the RPN's refusal to administer "as needed" meds promptly defeats the whole purpose of the med it's "AS NEEDED"! Also, her refusal to give the other meds according to the schedule recommended by the doctor was overriding the judgment of the doctor. If the RPN had been busy with something else, you would have understood, but she was not.
So there you have it - (1) RPN's personal gossip inteferes with patient's privacy, (2) RPN's behavior affects patient's nutrution, (3) RPN's refusal to adminisiter "as needed" meds promptly and other meds on time was done with no good reason and contradicted the schedule recommended by the doctor.
Remember - when you talk to the head nurse, do NOT make this about you versus the RPN. In fact, do not make it about you at all. It's about your husband's well-being. If the nurse has any brains, he/she will get the message.
I agree with the ladies advice. Realize that POA means basically nothing to a nurse's aid or even a nurse not in charge. By keeping it about how this lady is treating your husband and the negative effect it is having on his health is the way to go. If all else fails you can go higher up. But, at the very least the head nurse should remove her from your husband's care and assign another aide. Who knows, maybe the aide is a controller and somehow feels threatened because you are not allowing her to control your husband. I don't know, but something is going on. Would be interesting to know if he is the only one or all her patients are treated with so little compassion and concern.
Thank you all so much for responding. Old friends of my DH from about 70 years ago have been vacationing in Alaska and will, in a few days, stop off in our city for 3-4 days to visit Rene and a cousin of theirs. We (through me) have kept in touch with this couple in the last 7 years via email and phone, although I have never met them. His friends, of course, are very sad about his health. His friend’s field was chemistry, and while he may not be up on the meds, I thought I would request a copy of DH’s meds, if he asks. (He takes a lot of meds.)
This morning I phoned the Director of Care and left a message asking if we could get the meds list, saying I could pick it up after noon today. I went directly to her office; she invited me in and closed the door (I’m sure she’s heard stories, as last night, for my benefit, I’m sure, just as we were exiting the dining room, J. turned to a PSW and said “I’m so glad I went to see … (DoC)). This is after I returned the meal he didn’t like.
I told the DoC that I came today only for the list. She asked how things were. I told her that I loved the Home, and that, with one exception, the staff were very kind and caring, and I really appreciated the care DH was getting. I said I didn’t want to discuss it just now, but briefly, I was having a problem with J., particularly around meds and meal times. I said I’d made some notes (log-type), and would like to present them in a week or so after I reviewed them and was not so stressed. She listened carefully, and said that I could come at any time to discuss it further and to review my notes.
I mentioned the meal ordering, explaining that I KNEW my DH, plus I always asked him in advance, even though he didn’t always ‘get it’. She said the idea behind asking the patients was that the Ministry wanted to respect patients’ rights, but since she knew he was severely compromised she saw no reason why I could not order. (At supper time tonight, J. came and asked “What would you like to order?” in a pleasant tone. Looks like that message got through.)
I told the DOC that I felt J. was playing games, and almost deliberately delaying the meds to stress me out, resulting in stress for my DH. Today the RN (J.’s superior) told me that the overnight PSWs found he was waking about 4-4:30 a.m. because the meds had worn off … she suggested we give the meds an hour later. I said I’d be fine with that (I won’t mind waiting that hour if J. is on duty, just so I know he’s ok). Tonight about 15 minutes before the new meds time, J. came in with his meds, telling me that she had an emergency and asking if I’d like to give them to him at the new time. I said I would definitely do that, I thanked her, and we said goodnight.)
So, is it possible that a reset button has been pressed? The DoC and RNs know my feelings, and this Home has a reputation for dealing quickly with problems and J. is not on permanent staff, although I think she is trying hard to be.
I will review all of the wonderful advice you’ve given. I’m very grateful. Will keep you up to date.
I will rehearse - what a great idea – and I will ask SIL to listen to my rehearsal and accompany me. He’s not afraid to tell me what he thinks, and he can be objective. Over the last few months he has been my rock.
Charlotte, you are such a great person yourself, and I don't believe I could handle all the problems you have faced nearly half as well. You always give great advice and support (and I admire the way you and the other ladies have given it with so few words, but always the message gets through). Kindest regards,
I don't know if this is the discussion to put this but I have found a way that gets attention in the nursing home for my husband. I had a breakdown right in the middle of the lobby with the charge nurse, the administrator, and the office billing supervisor and everyone coming in and out. Not that I would advise anyone to do that. I had no control over it. But now they are very concerned with making sure he is getting physical therapy in the form of walking with assistance even though he has used all his days of medicare billing. The CNA's are doing it. They are proud to show me his progress and taking a personal responsibility in making sure he gets it. He is doing way better than he did going to physical therapy and getting billed thousands of dollars for 15 minutes of mediocre therapy and sitting the rest of the hour. I think they know I drive two hours there and back to see him for the hour before lunch and help him eat before he is down for a nap. I can't stay for him to wake up as that puts me home too late and my night driving sucks. Or perhaps they don't want another scene in the lobby.
jules, Your breakdown is completely understandable. It is a shame that you were pushed to that point only because you wanted the best possible care for your husband. I know it makes you feel better to see him getting this small amount of needed attention he deserves. Go ahead a create another scene in the lobby if that gets their attention! I do hope you are feeling better now. I'm with you on that night driving which is becoming a real nightmare for me. Sending a big (((hug)) to you friend.
jules, I'm glad to know I'm not the only one who had a breakdown in the lobby. Got everyone's attention, didn't it? I was then labeled "difficult" by the social worker and staff. They never seemed to understand that it was they who caused it.
Glad it's resulted in improved care for your husband.
LFL, sorry you also had a meltdown. I suppose I am also labeled difficult and they may only do stuff to placate me when I'm there. But I do see improvement in my husbands outward appearance of well being so I'm happy for that. Thanks for the (((hug))) AliM. I can use all of those I can get.
I think I must be following in Nikki's footsteps. She is a great role model.